Nipple Surgery
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*Tap a patient image to enlarge & view the full series of pre and post-operative images.
Inverted Nipple Repair
Patient A - Pre-operative and post-operative inverted nipple repair
Before the Surgery:
+ What is an Inverted Nipple?
A typical female nipple will project from the surrounding areola and breast to form the apex of the breast. The amount of nipple projection varies greatly. This projection is exaggerated when a person is cold or excited. This is because the muscle within the areola and nipple contracts when stimulated, to increase the nipple projection and reduce the size of the areola. The nerve that carries sensation to the nipple is also responsible for stimulating this muscle to contract. If this nerve is damaged, the sensation to the nipple is lost, in addition to the nipple’s ability to project with stimulation.
+ What happens with an inverted nipple?
There are about 20 ducts (lactiferous ducts) that drain the breast lobules which produce the breast milk. This breast milk drains from the breast lobules through the lactiferous ducts to the nipple during breast feeding. This allows the infant to successfully breast feed. If the ducts do not develop properly, there is no connection between the breast lobules and the nipple, so the breast milk cannot be delivered to the infant. If the nipple is severely inverted then the lactiferous ducts have not developed properly and are severely tethered. There is no connection between the breast lobules and the nipple. Even with manual manipulation, the nipple will not evert. In this circumstance, successful breast feeding is unlikely. There may be varying degrees of this tethering effect from underdeveloped lactiferous ducts. Patients with a lesser degree of nipple inversion and tethering may still be able to breast feed. In some instances, the loss of breast volume from weight loss or loss of breast volume after pregnancy and breast feeding may lead to nipple inversion. This is caused by the loss of the underlying breast tissue to support the nipple. It then collapses. There are certain types of breast cancer that present with nipple inversion and a bloody nipple discharge. A sudden change in the nipple should be assessed by your physician and appropriately investigated and the patient referred to a breast cancer surgeon.
+ Can an inverted nipple be corrected?
The correction is surgical and will eliminate any future possibility of breast feeding.
If the patient has a mild to moderate nipple inversion and wants to breast feed, the correction should be delayed until after she has completed her family and has had a trial of breast feeding. With mild to moderate nipple inversion, there may still be the opportunity to successfully breast feed.
The Operation:
+ How is the operation performed?
This procedure is done under local anaesthesia (freezing)
There are numerous techniques described to correct the inverted nipple:
- There is an incision made around the nipple and areola area.
- The tethered lactiferous ducts are divided and released (that is why breast feed after the surgery is not possible) which allows the nipple to project.
- Local breast tissue is then used to support the newly projected nipple.
- The incision is closed with dissolving sutures.
- Healing takes 7-10 days
If the loss of nipple projection is caused by loss of breast volume, and the patient wants to increase the breast size, then a breast augmentation procedure may restore the nipple projection by increasing the underlying support of the breast tissue and nipple.
The Risks:
+ What are the risks of doing an inverted nipple repair?
With any surgery there are surgical and anesthetic risks.
Aside from the rare risks of an anesthetic event, some of the general and specific surgical risks for this procedure would include:
Scarring
Nipple tissue loss
Infection
Sensation change to the nipple
Discomfort
Asymmetry
Bleeding (hematoma)
if you take blood thinning medication, this must be stopped at least one week prior to surgery and one week after surgery
*This list is not complete.
During the consultation with the patient, Dr. Giuffre will outline and explain each of the risks in detail.
The Followup:
+ How often do I need to come back for a checkup after the surgery?
Postoperative visits include:
a 1 week post op visit
a 6 week visit in the office to review the preoperative photograph and the surgical result.
The patient is allowed to shower the following day. Aggressive sports activity should be avoided for 2 weeks.
If there are any patient concerns, Dr. Giuffre provides his home phone number for patient's direct access.
After the 6 week visit, if there are any future requests for an appointment, they are made directly with Dr. Giuffre’s office and an expedited visit is arranged.
Financing:
+ Will AHS (Alberta Health Services) cover Nipple Inversion surgery?
Nipple inversion correction breast surgery is not covered by Alberta Health Services.
+ Can I finance the costs of the surgery? How do I do this?
Dr. Giuffre does not provide in house financing for cosmetic procedures.
There are a number of companies across Canada that will finance cosmetic surgery, similar to car financing or mortgages.
Please refer to the links provided on the Home Page for this information. Dr. Giuffre has no financial or business relationship or affiliation with any of these companies.
Asymmetry Correction
Before the Surgery:
+ My nipple areola sizes are different on one breast compared to the other breast. Can this be corrected?
Absolute breast symmetry is very uncommon (<5%). data-preserve-html-node="true" If there is a significant difference in nipple areola size asymmetry, this can be corrected.
Often this asymmetry is because both breasts are asymmetrical, in which case, the correction is to surgically treat both the breast and nipple areola asymmetry together.
Please see FAQ Breast Asymmetry
If the breasts are symmetrical and the nipple areola size is different between both breasts, this can be treated surgically to improve symmetry.
This surgery is done under local anaesthesia (freezing).
The surgery will leave scarring around the nipple areolar area.
+ My nipple areola heights are different on one breast compared to the other breast. Can this be corrected?
Often this asymmetry is because both breasts are asymmetrical in which case the correction is to surgically treat both the breast and nipple areola asymmetry together.
Please see FAQ Breast Asymmetry
If the breasts are symmetrical, and the nipple areola heights are minimally different between both breasts, this can be treated surgically to improve symmetry by raising the lower nipple areola to match to opposite breasts.
This surgery is done under local anaesthesia (freezing).
The surgery will leave scarring around the nipple areolar area.
The Risks:
+ What are the risks of assymetry correction?
With any surgery there are surgical and anesthetic risks.
Aside from the rare risks of an anesthetic event, some of the general and specific surgical risks for this procedure would include:
- Scarring
- Nipple tissue loss
- Infection
- Sensation change to the nipple
- Discomfort
- Asymmetry
- Bleeding (hematoma) - if you take blood thinning medication, this must be stopped at least one week prior to surgery and one week after surgery
*This list is not complete.
During the consultation with the patient, Dr. Giuffre will outline and explain each of the risks in detail.
The Followup:
+ How often do I need to come back for a checkup after the surgery?
Postoperative visits include:
- a 1 week post op visit
- a 6 week visit in the office to review the preoperative photograph and the surgical result.
The patient is allowed to shower the following day. Aggressive sports activity should be avoided for 2 weeks.
If there are any patient concerns, Dr. Giuffre provides his home phone number for patient's direct access.
After the 6 week visit, if there are any future requests for an appointment, they are made directly with Dr. Giuffre’s office and an expedited visit is arranged.
Financing:
+ Will AHS (Alberta Health Services) cover nipple surgery?
Nipple correction breast surgery is not covered by Alberta Health Services.
+ Can I finance the costs of the surgery? How do I do this?
Dr. Giuffre does not provide in house financing for cosmetic procedures.
There are a number of companies across Canada that will finance cosmetic surgery, similar to car financing or mortgages.
Please refer to the links provided on the Home Page for this information.
Dr. Giuffre has no financial or business relationship or affiliation with any of these companies.
Nipple Reduction
Before the Surgery:
+ My nipples project too far. Can I have them reduced?
There is a large variance in the amount of nipple projection in a typical female breast.
If the amount of nipple projection is excessive, this can be reduced surgically.
This surgery should be considered only after the patient has completed her family or the patient does not intend to breast feed. The surgical correction of an over projected nipple will often interfere or eliminate the opportunity to breast feed.
The Operation:
+ How is the operation performed?
This procedure is done under local anaesthesia (freezing).
- There are numerous techniques described to correct the over projected nipple.
- There is an incision made around the nipple area.
- The over projection can be completely eliminated to create a flat smooth areola, OR
- The over projection can be reduced but still leave some degree of projection depending on the patient’s wishes.
- The incision is closed with dissolving sutures.
Healing takes 7-10 days
The Risks:
+ What are the risks of nipple reduction surgery?
With any surgery there are surgical and anesthetic risks.
Aside from the rare risks of an anesthetic event, some of the general and specific surgical risks for this procedure would include:
- Scarring
- Nipple tissue loss
- Infection
- Sensation change to the nipple
- Discomfort
- Asymmetry
- Bleeding (hematoma): if you take blood thinning medication, this must be stopped at least one week prior to surgery and one week after surgery
*This list is not complete.
During the consultation with the patient, Dr. Giuffre will outline and explain each of the risks in detail.
The Followup:
+ How often do I need to come back for a checkup after the surgery?
Postoperative visits include:
- a 1 week post op visit
- a 6 week visit in the office to review the preoperative photograph and the surgical result.
The patient is allowed to shower the following day. Aggressive sports activity should be avoided for 2 weeks.
If there are any patient concerns, Dr. Giuffre provides his home phone number for patient's direct access.
After the 6 week visit, if there are any future requests for an appointment, they are made directly with Dr. Giuffre’s office and an expedited visit is arranged.
Financing:
+ Will AHS (Alberta Health Services) cover nipple surgery?
Nipple correction breast surgery is not covered by Alberta Health Services.
+ Can I finance the costs of the surgery? How do I do this?
Dr. Giuffre does not provide in house financing for cosmetic procedures.
There are a number of companies across Canada that will finance cosmetic surgery, similar to car financing or mortgages.
Please refer to the links provided on the Home Page for this information.
Dr. Giuffre has no financial or business relationship or affiliation with any of these companies.
Areolar Reconstruction
Patient C - Breast Reconstruction with a Latissimus Doris musculocutaneous flap. This is used for patients who have had radiation after a breast mastectomy and require additional tissue to reconstruct the breast mound. An immediate reconstruction was done on the Left Breast following a prophylactic skin sparing mastectomy. Slider shows patient post-operatively, following bilateral nipple and areola reconstruction, following mastectomy.
NO tattooing was used.
Before the Surgery:
+ Can I have a areolar reconstruction?
Women who have had breast cancer surgery, where the breast and nipple areola have been removed to treat the cancer, often undergo breast reconstruction after the surgery.
Please see FAQ Breast reconstruction following breast cancer
The last stage of the reconstruction after the breast mound is reconstructed, is to have the nipple areola reconstructed. This converts the breast mound into a more natural looking breast.
One option is a medical 3-D nipple areola tattoo placed on the reconstructed breast mound. This provides an excellent color and size match to a typical nipple areola but the tattoo is flat. There is no nipple projection.
The other, and more popular option, is to have a surgical nipple areolar reconstruction. This produces a nipple projection and areola surrounding the reconstructed nipple. This technique does not always produce the desired color match the patient desires. Over tattooing of the areola would then be required 3-6 months after the completion of the reconstruction to produce a more favorable color match. If the color match is satisfactory or the color is not an issue, then patients will forgo the tattooing option.
Some patients do not proceed with a nipple areola reconstruction following a breast reconstruction of the breast mound.
In the rare instance where a nipple areola is partially or completely lost following a breast reduction operation, a similar approach to nipple areola reconstruction is taken.
The Operation:
+ How does the nipple tattoo procedure work?
Nipple tattooing is done like any regular tattoo
Nipple Tattoo
Left Breast nipple tattoo using a 3D technique.
There is no nipple projection but the size and colour match are close to the natural right breast nipple.
+ How does the surgical procedure work?
This surgical procedure to build a nipple and areola is done under general anaesthesia as a Day procedure, (the patient goes home the same day).
There are numerous techniques described to create a nipple projection.
- The areola is created using a skin graft (harvested from the groin or lateral breast) and placed around the reconstructed nipple.
- A special dressing (bolus) is placed around the reconstructed nipple and areola. This is left in place and undisturbed for 5-6 days. The patient must keep this dressing dry (no shower).
- At 5- 6 days, all the bandages and the bolus dressing is removed. The patient can then shower.
- The incision around the areola is closed with dissolving sutures. All other sutures are removed.
Healing takes 7-10 days
The patients may shower daily, but should avoid strenuous sports for 6 weeks.
The Risks:
+ What are the risks of areolar reconstruction?
With any surgery there are surgical and anesthetic risks.
Aside from the rare risks of an anesthetic event, some of the general and specific surgical risks for this procedure would include:
- Scarring
- Nipple tissue loss because of graft loss
- Infection
- Sensation change: the reconstructed nipple and areola will not have sensation
- Discomfort
- Asymmetry
- Bleeding (hematoma): if you take blood thinning medication, this must be stopped at least one week prior to surgery and one week after surgery
*This list is not complete.
During the consultation with the patient, Dr. Giuffre will outline and explain each of the risks in detail.
The Followup:
+ How often do I need to come back for a checkup after the surgery?
Postoperative visits include:
- a 1 week post op visit
- a 6 week visit in the office to review the preoperative photograph and the surgical result.
The patient is allowed to shower after the first dressing change at day 5-6. One week off work is recommended. Aggressive sports activity should be avoided for 6 weeks.
If there are any patient concerns, Dr. Giuffre provides his home phone number for patient's direct access.
After the 6 week visit, if there are any future requests for an appointment, they are made directly with Dr. Giuffre’s office and an expedited visit is arranged.
Financing:
+ Will AHS (Alberta Health Services) cover nipple surgery?
Nipple reconstruction following breast cancer surgery is covered by Alberta Health Services.
Accessory Nipple
+ What is an accessory nipple?
- The breast develops along a “milk line’ that extends from the axilla (arm pit area) to the groin. This milk line is present as the embryo develops into a fetus and then into a new born. A breast and or nipple can develop anywhere along this milk line.
- In the vast majority of women and men, the breast and nipple develop normally in their correct location.
- An aberrant nipple can occur along the milk line. It may appear as a small mole like projection called an accessory nipple or it may appear as a full nipple.
- The most common location for an accessory nipple is along the upper rib cage or the lower pole of the breast.
- This can be treated by removing the accessory nipple under local anaesthesia.
- The nipple and underlying breast tissue is removed and sent to pathology for analysis.
- The incision is sutured with a dissolving stitch.
- A small scar will be left where the accessory nipple was removed.
+ Will AHS (Alberta Health Services) cover nipple surgery?
Nipple cosmesis surgery is not covered by Alberta Health Services.
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